


Selected Records

by fanfoolishness (LoonyLupin), LoonyLupin



Series: Level 10: Agents of Shield Fic [1]
Category: Agents of S.H.I.E.L.D. (TV)
Genre: Angst, GH-325, Gen, Kree (Marvel), Medical, Medical Examination, Medical Jargon, Medical Trauma, Mental Breakdown, Post-Battle of New York (Marvel), Tahiti is a Magical Place
Language: English
Status: Completed
Published: 2015-08-03
Updated: 2015-08-03
Packaged: 2018-04-12 18:05:25
Rating: General Audiences
Warnings: No Archive Warnings Apply
Chapters: 7
Words: 2,971
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/4489461
Author URL: https://archiveofourown.org/users/LoonyLupin/pseuds/fanfoolishness, https://archiveofourown.org/users/LoonyLupin/pseuds/LoonyLupin
Summary: <blockquote class="userstuff">
              <p>Director Nick Fury purposely neglected to reveal the entirety of Phil Coulson's medical records.  Please see the following for a selection of pertinent examinations.</p>
            </blockquote>





	1. October 1, 2012

**Date:** October 1, 2012

 **Patient:** Phillip Coulson, Agent, Level 8

 **Temperature:** 97.1 F

 **Pulse:**  72

 **Respiration:**  16

 **Blood pressure:**  90/55 mm Hg

 **Weight:**  165 lbs, BMI 24

**SUBJECTIVE**

Patient is friendly and cheerful in demeanor, making jokes and inquiring about when it may be time to return to work.  Normal appetite and thirst.  Normal sleeping habits per patient.  Patient reports some lingering discomfort at the site of the fatal wound but has not asked for pain relief stronger than ibuprofen 800mg in over one week.  Patient states that overall he is feeling excellent, but impatient to get back into the field.

Patient reports dreaming of working on a red Corvette with his deceased father and describes the dream as peaceful and pleasant, if mundane.

**OBJECTIVE**

General: Bright, alert, friendly.  Normal demeanor and hygiene.  

Skin: 35cm x 10cm jagged scar on left thorax and abdomen extending from level of T7 to the navel, tender on palpation.  Scarred skin is mildly fragile.  Wound contraction proceeding as expected.

EENT:  Eyes and ears clear, no nasal discharge, within normal limits.

Cardiovascular: Normal rate and rhythm, no murmur ausculted, pulses within normal limits.

Respiratory: Within normal limits

Glandular/lymph node: Within normal limits

Musculoskeletal: Moderate diffuse muscle wasting in left arm consistent with decreased use.  Mild reduction in range of motion of left arm.

Urogenital: Within normal limits

Abdominal: Within normal limits

Extremities: Within normal limits

Neurologic: Mentally appropriate, normal proprioception

**ASSESSMENT**

Normal demeanor and attitude.  

Physical status as expected given severity of initial condition.  Muscular condition is improving.  

No evidence of adverse effects from GH-325 as previously reported in other patients.

**PLAN**

Continue physical therapy for left arm

Continue ibuprofen 800mg PO BID-TID PRN

Continue monitoring physical and mental status

Continue logging dreams


	2. December 11, 2012

**Date:**  December 11, 2012

**Patient:**  Phillip Coulson, Agent, Level 8

**Temperature:**  97.3 F

**Pulse:**  68

**Respiration:**  14

**Blood pressure:**  89/54 mm Hg

**Weight:** 161 lbs, BMI 24

**SUBJECTIVE**

Patient is friendly and polite, but expresses frustration and boredom at needing to remain in hospital.  Patient states that he feels great and that he is ready for field work as soon as he can be cleared.  Patient requests some new books to read as he has finished those available to him.  Normal appetite, thirst, and sleeping habits per patient.  Per patient his wound is less painful than before.  Patient appears to be in good spirits.  No current medications.

When asked to discuss dreams patient becomes evasive and jokes to deflect the question.  Patient remains friendly and affable but is not eager to share his dreams.  When pressed patient states that he dreamed something upsetting but does not remember it anymore.

**OBJECTIVE**

General: Bright, alert, friendly.  Normal demeanor and hygiene.  

Skin: 35cm x 10cm jagged scar on left thorax and abdomen extending from level of T7 to the navel, not painful on palpation.  

EENT:  Eyes and ears clear, no nasal discharge, within normal limits.

Cardiovascular: Normal rate and rhythm, no murmur ausculted, pulses within normal limits.

Respiratory: Within normal limits

Glandular/lymph node: Within normal limits

Musculoskeletal: Mild diffuse muscle wasting in left arm consistent with decreased use.  Mild reduction in range of motion of left arm, improved from last assessment..

Urogenital: Within normal limits

Abdominal: Within normal limits

Extremities: Within normal limits

Neurologic: Mentally appropriate, normal proprioception

**ASSESSMENT**

Physical improvement continues.  Muscular condition is improving.

Patient has not been reluctant to discuss dreams before.  Rule out initial adverse effects from GH-325 treatment vs. normal reluctance to discuss unpleasant dreams.  

**PLAN**

Continue physical therapy and rehabilitation exercises

Increase monitoring of mental status and sleep activity

Continue to monitor for adverse effects of GH-325 administration


	3. January 4, 2013

**Date:** January 4, 2013

 **Patient:** Phillip Coulson, Agent, Level 8

 **Temperature:** 97.1 F

 **Pulse:**  76

 **Respiration:**  18

 **Blood pressure:**  95/60 mm Hg

 **Weight:**  157 lbs, BMI 22

**SUBJECTIVE**

Patient is friendly when greeted but quiet today.  When asked if something is troubling him patient states no.  Patient has no complaints of pain or trouble sleeping.  However, sleep studies from the previous night show four separate waking events.  Patient does not remember waking up.  Normal appetite and thirst per patient.

Patient reports dreaming of an endless sea and people talking in a language he does not understand.  When asked to elaborate patient becomes withdrawn and does not wish to continue the conversation, askiing to return to his room.

**OBJECTIVE**

General: Quiet, alert, friendly.  Subdued demeanor.  Normal hygiene.

Skin: 33cm x 9cm jagged scar on left thorax and abdomen extending from level of T7 to the navel.  Fully healed.  

EENT:  Eyes and ears clear, no nasal discharge, within normal limits.

Cardiovascular: Normal rate and rhythm, no murmur ausculted, pulses within normal limits.

Respiratory: Within normal limits

Glandular/lymph node: Within normal limits

Musculoskeletal: Muscling in left arm is improved and nearly equal to the right arm.  Range of motion is still slightly limited in left arm compared to right.

Urogenital: Within normal limits

Abdominal: Within normal limits

Extremities: Within normal limits

Neurologic: Mentally appropriate, normal proprioception, subdued mood.

**ASSESSMENT**

Physical improvement continues.  Muscular condition is nearly restored to initial conditions.

Patient is exhibiting interrupted sleep, subdued mood, weight loss, and dreams of the sea.

Suspect patient is developing signs of adverse effects from GH-325 treatment as consistent with previous patient responses, despite altered dose and protocol in this patient.

**PLAN**

Continue physical therapy and rehabilitation exercises

Consider psychiatric intervention if symptoms continue to progress

Continue sleep monitoring


	4. February 2, 2013

**Date:**  February 2, 2013

**Patient** : Phillip Coulson, Agent, Level 8

**Temperature:**  98.1 F

**Pulse:**  80

**Respiration:**  20

**Blood pressure:** 120/75 mm Hg

**Weight:**  154 lbs, BMI 22

**SUBJECTIVE**

Patient is quiet today and rarely makes eye contact during conversation.  When asked if patient is experiencing pain patient says nothing.  When asked a second time patient shakes his head no.  Patient reports a reduced appetite and says that something seems to be wrong with the food but does not elaborate.  Patient asks for new books again, stating the ones that have been delivered to him are boring.  Patient reports feeling restless when trying to sleep.  Sleep study data show eight waking events during the previous night’s sleep.

Despite poor sleep hygiene patient reports that he dreamed “a lifetime’s” worth of dreams last night.  When asked to discuss what he dreamed about patient became agitated and refused to speak.  When repeatedly questioned patient requested calmly to be left alone, and asked to end the interview.

**OBJECTIVE**

General: Quiet demeanor, anxious expression.  Hair is mussed and patient, normally clean-shaven, exhibits stubble.

Skin: 33cm x 9cm jagged healed scar on left thorax and abdomen extending from level of T7 to the navel.

EENT:  Mild dilation of pupils.  Ears clear, no nasal discharge.

Cardiovascular: Normal rate and rhythm, no murmur ausculted, pulses within normal limits.

Respiratory: Within normal limits

Glandular/lymph node: Within normal limits

Musculoskeletal: Muscling in left arm is improved and nearly equal to the right arm.  Range of motion is still slightly limited in left arm compared to right.

Urogenital: Within normal limits

Abdominal: Within normal limits

Extremities: Within normal limits

Neurologic: Patient folds and unfolds his hands in his lap repeatedly and does not appear to be aware of the behavior.  Normal proprioception and gait.  Agitated mood, normal mentation.

**ASSESSMENT**

Wound is fully healed

Mild impairment in range of motion of left arm

Weight loss, reduced appetite, frequent waking, borderline hypertension, vivid dreams, and agitation consistent with GH-325 exposure

**PLAN**

Continue physical therapy and rehabilitation exercises

Institute GH-325 adverse effect treatment protocol A

Institute suicide watch and modify patient’s room accordingly 


	5. March 19, 2013

**Date:** March 19, 2013 **  
**

**Patient:**  Phillip Coulson, Agent, Level 8

**Temperature:** 97.9 F

**Pulse:**  96

**Respiration:** 28

**Blood pressure:** 128/85 mm Hg

**Weight:**  149 lbs, BMI 22

**SUBJECTIVE**

Patient is currently undergoing GH-325 AETP-A.  Patient declined to perform physical therapy exercises today, stating he felt unwell.

When greeted for examination today patient was severely withdrawn.  Patient was difficult to rouse verbally.  When touched on the shoulder patient was hyperreactive; patient stood up and tried to hit me.  Patient realized it was me before making contact and apologized immediately, but appeared frightened by the incident.  Requested two aides in exam room before proceeding.  Aides remained present for remainder of exam.  Patient showed no further inclination towards violence or combative behavior.

Patient is very quiet today.  When questioned patient prefers to give only yes or no answers.  Per patient he is not sleeping well, is not hungry, and has normal thirst.  Patient says he does not want to read our books anymore because they are wrong.  When asked if he is in pain patient turns away and faces the wall.  Patient did not give a verbal response to this question.

When asked to discuss his dreams patient got up and tried to leave the exam room.  Patient required moderate restraint to prevent him from leaving the room.  Patient was not combative but struggled to get free of the aides until he was told he did not need to discuss dreams today.  At the end of the examination, patient stated, “I need to know,” but refused to provide further explanation.

During patient’s examination his sleeping quarters were examined.  Several lines of writing consisting of connected circles and diamonds, similar to those produced by other T.A.H.I.T.I. patients, were found carved in the wall behind the bed.  Carving width and depth was consistent with patient using his fingernails to create the patterns.  Blood stains were found in one of the lines.  See attached photos.

**OBJECTIVE**

General: Withdrawn demeanor.  Patient appears mildly sedated when not speaking.  When speaking, patient speaks more rapidly than normal.  Hair is mussed and patient exhibits stubble.  

Skin: 33cm x 9cm jagged healed scar on left thorax and abdomen extending from level of T7 to the navel.

EENT:  Mild dilation of pupils.  Ears clear, no nasal discharge.

Cardiovascular: Increased heart rate, no arrhythmia noted, no murmur ausculted, pulses within normal limits.

Respiratory: Within normal limits

Glandular/lymph node: Within normal limits

Musculoskeletal: Muscling in left arm is improved and nearly equal to the right arm.  Did not evaluate range of motion due to patient’s previous attempt to hit.

Urogenital: Within normal limits

Abdominal: Within normal limits

Extremities: All fingernails are bitten short.  The index and middle fingers of the right hand exhibit exposure of the quick and have dried blood around the cuticles.  

Neurologic: Normal proprioception and gait.  Withdrawn demeanor, hyperreactive to touch.  Patient is aware of his surroundings but appears paranoid and disturbed.

**ASSESSMENT**

AETP-A alone does not appear to be effective in reducing effects of GH-325

Weight loss and mood and sleep disturbances are worsening

Hypergraphia and secondary self-mutilation present

**PLAN**

Discontinue physical therapy until mental status improved

Institute GH-325 adverse effect treatment protocols B and C in addition to AETP-A

Institute restraints at night to reduce inadvertent self-mutilation secondary to hypergraphia

Despite patient’s previously stated refusal of the full T.A.H.I.T.I. protocol prior to his death, consider institution of complete protocol if AETPs ineffective


	6. April 19, 2013

**Date:** April 19, 2013

 **Patient:**  Phillip Coulson, Agent, Level 8

 **Temperature:**  99.1 F

 **Pulse:** 120

 **Respiration:**  40

 **Blood pressure:**  140/100 mm Hg

 **Weight:** 141 lbs, BMI 20

**SUBJECTIVE**

Patient is currently undergoing GH-325 AETP-A, B and C.

Patient began to cry when brought into exam room.  When asked what had upset him patient shouted that he had been “chosen” and that he needed to write the words.  Patient continued to shout, demanding a knife so he could write.  Patient was told he could not have a knife right now but could be given one later as a reward for good behavior.  Patient allowed himself to be seated with the help of aides but continued crying for several minutes before calming.

When patient was calm, he was asked about his appetite and stated that food was no longer important.  Patient also stated sleep was “an unnecessary burden.”  Per patient he is not painful “in the world,” but “out of it, yes, it hurts all the time.  No one said birth was easy, you know.”  

Patient appeared calm and relaxed during this portion of the interview.  Patient was asked if he knew his name.  Patient answered, “Coulson,” but did not give a first or middle name.  Patient was asked his first name but shook his head and smiled instead of answering.  Patient was asked if his first name was Phillip.  Patient said no and laughed.

When asked about his dreams, patient stated the following:

[ _Transcript of voice recording_ : “I wish you could see it.  …I think you’re worried about me, and that’s nice of you, but you don’t need to be. _(laughter)_   I see it all.  Those ancient hallways, the endless sea, their voices calling me home.  I’m just trying to get there.  I’m asking you to not get in my way.  I need to know.  I just need to let it out and then I’ll see it, then I’ll understand, everyone’s going to picture this.  Monsters and monuments, there’s a beauty that burns in the dark and you’re going to help me find it.  I need to know.  _(shouting)_   I need to know!  I need to know!”]

Patient became combative and required restraint and sedation for the remainder of exam.  Administered intramuscular haloperidol 10mg and promethazine 30mg in right dorsogluteal muscle.  Adequate sedation was achieved for physical exam.

**OBJECTIVE**

General: Prior to sedation, patient appeared alternately sad, calm, jubilant, and angry.  Patient exhibited rapid speech patterns consistent with manic state.  Hair is mussed, stubble is present, and clothing has been torn by patient.  Patient is sweating and does not appear to have bathed for a few days.

Skin: 33cm x 9cm jagged healed scar on left thorax and abdomen extending from level of T7 to the navel.

EENT:  Prior to sedation, bilateral mydriasis present.  Ears clear, no nasal discharge.

Cardiovascular: Tachycardia, no arrhythmia or murmur ausculted, bounding pulses.

Respiratory: Within normal limits

Glandular/lymph node: Within normal limits

Musculoskeletal: Normal muscling in both arms and chest

Urogenital: Within normal limits

Abdominal: Within normal limits

Extremities: Cuticles of fingernails all exhibit 1-3mm partial to full thickness wounds.  Nails are bitten with quicks exposed.  Tips of right index and middle fingers exhibit superficial and deep abrasions.  Dried blood is present on multiple fingertips.

Neurologic: Prior to sedation patient exhibited rapid cycling of moods, pressured speech, agitation and violence.

**ASSESSMENT**

GH-325-induced psychosis unresponsive to treatment

**PLAN**

Recommend full institution of T.A.H.I.T.I. protocol immediately despite absence of consent.  Patient suffering demands full treatment and independent recovery from GH-325-induced psychosis has not yet been demonstrated.  Despite alterations in serum administration and resurrection protocols in this patient, the psychotic state has developed similarly in all patients to date.  

Schedule modification procedure for tomorrow to prevent further fragmentation of patient.


	7. July 30, 2013

**Date:** July 30, 2013

**Patient:**  Phillip Coulson, Agent, Level 8

**Temperature:**  97.9 F

**Pulse:** 66

**Respiration:**  14

**Blood pressure:**  85/55 mm Hg

**Weight:**  155 lbs, BMI 23

**SUBJECTIVE**

Patient is friendly and cheerful in demeanor, and presents a firm handshake when greeted.  Patient expresses interest in returning to work soon.  Patient says he is glad for the books in his room as they give him something to do.  Patient states he is eager to be cleared for active duty.

Per patient appetite is normal or slightly increased.  Patient mentions his clothes seem too loose and requests more cheeseburgers from the cafeteria.  Patient reports he is sleeping well.  When asked if he enjoyed his time in Tahiti, patient answers, “It’s a magical place.”  Patient appears content when Tahiti is discussed.

When asked if patient recalls the last few months, patient states he remembers being badly injured prior to the Battle of New York, waking up in a hospital bed, and seeing palm trees out the window.  Patient states fondly that he has never seen such beautiful beaches.

Patient reports he dreamed of getting a fresh cup of coffee, but the coffee turned into bacon and eggs and when he went to complain, the waitress turned into a tabby cat.  Patient states he knows that sounds ridiculous.

**OBJECTIVE**

General: Bright, alert, friendly.  Patient is well-groomed and confident.  Hair on head has almost completely grown back from where it had been shaved.

Skin: 33cm x 9cm jagged healed scar on left thorax and abdomen extending from level of T7 to the navel.  Faint scar present on forehead, scar is fading and is difficult to see.

EENT:  Eyes within normal limits.  Ears clear, no nasal discharge.

Cardiovascular: Normal rate and rhythm, no murmur ausculted.

Respiratory: Within normal limits

Glandular/lymph node: Within normal limits

Musculoskeletal: Normal muscling in both arms and chest, normal range of motion in both arms

Urogenital: Within normal limits

Abdominal: Within normal limits

Extremities: Nails are short and well-groomed, extremities within normal limits.

Neurologic: Appropriate mentation, calm, friendly demeanor.  Normal gait and proprioception.

**ASSESSMENT**

GH-325-induced psychosis - resolved via T.A.H.I.T.I. protocol.  Memory alteration appears complete.

Reports from physical therapist and martial arts instructor indicate patient’s physical acumen is 95% of that prior to patient’s death and should continue to improve.

S.H.I.E.L.D. personality test results indicate mild but statistically significant increases in patient’s optimism, trust, and disregard for rules following institution of the protocol.  S.H.I.E.L.D. psychologist review board indicates patient’s essential character remains intact and mild differences between pre- and post-death personality are unlikely to result in ill effects.

**PLAN**

Recommend reinstatement in the field with appropriate monitoring conditions.  It is important that lack of awareness of the T.A.H.I.T.I. protocol is maintained, as knowledge of the program has resulted in relapse of psychosis in previous patients.   **Recommend patient be paired with an appropriately briefed handler for ideal results.**   Granted that patient unawareness is maintained, prognosis for full return to function is **excellent**.

**Author's Note:**

> I'm a veterinarian... not a human doctor. I don't know if human doctors use the SOAP (subjective/objective/assessment/plan) format, but this is pretty similar to how I write my records. Might remix this with some Coulson-perspective down the line, but I rather like the starkness of it like this, too.


End file.
